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Roger Berry (Kingswood) (Lab): With respect to the Conservatives making their mind up, does my right
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hon. Friend agree that there is something strange about Conservatives in my area signing up to the Bristol health services plan for reconfiguration, along with the other political parties, and then realising that they can exploit a part of the plan for political reasons and going ahead, with the support of the hon. Member for South Cambridgeshire (Mr. Lansley), in campaigning against their publicly stated position? Do they not need to be consistent?

Ms Hewitt: I have long since learned —[ Interruption. ]

Madam Deputy Speaker: Order. There is far too much noise in the Chamber.

Ms Hewitt: Thank you, Madam Deputy Speaker. I have long since learned not to be surprised by any degree of inconsistency on the part of Conservative Members.

Angela Watkinson (Upminster) (Con): The Secretary of State said that consultations are real, but the Barking, Havering and Redbridge Hospitals NHS Trust is about to embark on a public consultation exercise with five options, and before it has started, we have already been told that option 1—the choice of most members of the public, as it does not involve any closures—is not viable, that there is no point in choosing it and that the NHS has already identified its preferred option—option 4, which involves a further closure of one of my local hospitals. What confidence can people have in the genuineness of the consultation?

Ms Hewitt: I have no doubt at all that the local NHS in Barking, Havering and Redbridge will undertake a very full consultation on the future changes that need to be made in that part of London in order to give much better care, particularly to people living in some of the most disadvantaged communities in the country. The consultations must take place on the basis of an honest and grown-up conversation between the NHS and the local public about what is affordable and what the options are for getting the best possible care for all patients, including those who need hospital treatment and those who can be better cared for outside hospital, in order to ensure that the NHS delivers the best possible value for the additional investment that the hon. Lady’s constituents are making in it.

Mr. Nicholas Soames (Mid-Sussex) (Con): It is very kind of the Secretary of State to give way, even from behind her papers. I agree entirely with the point that she makes about the requirement for a serious, grown-up conversation about the services. The point that my hon. Friend the Member for Upminster (Angela Watkinson) made, however, applies in constituencies throughout the land, where serious grown-up conversations are taking place and people acknowledge that changes need to be made, but where local people know that lines in the sand are needed to protect services that are vital for local people, such as proper A and E and maternity services. When vast numbers of those people, after serious conversations, object to what is proposed, what then should happen?

Ms Hewitt: Thanks to the changes that we have made in the whole statutory framework for
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consultation, there is now a very clear process of initial involvement with the public and staff to generate the options and formal consultation on those options, with the involvement throughout the entire process of the local overview and scrutiny committees. In many cases—it is probably the majority of cases in which reconfigurations take place—the issues are settled through the process with the support of the local councillors on the overview and scrutiny committee. It is only if the committee is not happy with the outcome, the consultation process or both that the matter even comes to me as Secretary of State. Depending on the strength of the clinical case and the nature of the objections that are being made, what I am able to do—I have done it in a number of cases—is bring in an independent panel of clinicians to take a further look from outside the area at the decisions that are proposed locally. I think that that is the right way to deal with decisions that are often difficult, but need to be made in a way that ensures the best care possible for everybody in every part of the country.

I have spoken, as the hon. Member for South Cambridgeshire did, about the changes taking place that bring health services closer to people’s homes. At the same time, however—he made some play of this—modern medicine is becoming even more complex, and some patients will need to go further away in order to get the specialist care that they need. He referred to primary angioplasty services. A few weeks ago, at St. Bart’s hospital in London, I met a gentleman, Mr. Singh, who had suffered a major, life-threatening heart attack just two days earlier. His wife called 999, the ambulance arrived and highly skilled paramedics diagnosed him, took him straight past two or three local A and Es in that part of London and got him straight to the chest clinic. As the clinic has the round-the-clock specialist team that it needs, Mr. Singh had the operation that he needed—primary angioplasty—just 90 minutes after suffering his heart attack. Just two days later, he went home.

Those improvements are happening now, and have been doing so for the past few years in London. They are happening on Teesside, as we heard earlier, and in some other parts of the country. We want that improvement, and we are determined to secure it for every patient who needs it in every part of our country. Professor Roger Boyle, the highly expert and esteemed national clinical director for heart disease and stroke, has recently estimated that if such primary angioplasty services were available throughout the country, the NHS would be able to save about 500 more people’s lives a year and prevent 1,000 further heart attacks. Of course there will not be such specialist services in every local hospital, because thankfully there are not enough patients to support and need a specialist team in every local hospital.

This is not about closing hospitals or downgrading services, whether in A and E or elsewhere. [Hon. Members: “It is.”] Are Opposition Members really saying that they do not want someone who has suffered a heart attack to be taken by ambulance to the specialist centre that will give them the best chance of having their life saved, and that they would rather have them taken to a local A and E that does not have the services that would save that person’s life?

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Mr. Tyrie: I am just wondering whether the Secretary of State has ever been to West Sussex. Does she not realise that, given the geography of the place, if Mr. Singh had had his heart attack in Selsey after, say, St. Richard’s hospital had been closed, he would never have got to a hospital in time? That is the problem that we have got. We need these hospitals because of the geography of the area and the distances involved. She simply has not grasped the reality of health provision on the ground.

Ms Hewitt: May I advise the hon. Gentleman to read Roger Boyle’s report and indeed to talk to his hon. Friend the Member for South Cambridgeshire? The hon. Member for South Cambridgeshire rightly referred to Australia, which has much better survival rates for stroke and, I believe, heart attack, and better availability of primary angioplasty services. The distances that people have to travel in that country are a great deal larger than anything that will be encountered in most parts of our country. In north Tees and other parts of the north-east, for instance, patients who have suffered a heart attack or stroke and need the specialist services of the excellent James Cook university hospital in south Tees are in many cases brought there by air ambulance, because it would take too long for them to travel by road ambulance to get the life-saving treatment that they need. That is another reason why such decisions need to be made locally, so that local ambulance services and hospital services can be organised in the best way.

Norman Lamb (North Norfolk) (LD): The Secretary of State has continued to assert that this is not about hospital closures. However, when she was interviewed by Jon Sopel last October and he asked her whether there will be a smaller number of hospitals with a full range of services—that is, A and E, maternity and paediatrics—she answered, “Almost certainly.”

Ms Hewitt: As I have said not only in this debate but on many other occasions, this is not about closing hospitals but it is about changing how hospitals work. As the debate has vividly illustrated, we will need more local facilities in the new health centres and improved GP surgeries, in people’s own homes, and in community hospitals; we will need more services like primary angioplasty in specialist centres, because that will save more lives; and we will need our local district general hospitals to do what only they can do.

Mr. Lansley: Where there is good clinical evidence that there needs to be a reconfiguration, the Government are promoting that argument. In January 2004, following a review of paediatric and congenital cardiac surgery, I asked the then Secretary of State why he had rejected its recommendation that there should be a minimum of 300 such units. He said that it was because it would require the closure of some of the most successful cardiac centres in the country, and he was not going to do that. Why did not he act on his own review’s recommendation that there needed to be a minimum throughput of operations?

Ms Hewitt: I am not aware of the exchange that the hon. Gentleman mentions. It is clear that the NHS is already building up more specialist centres—for
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cardiac patients, burns patients and so on—that will give people the best possible care with the best possible chance of saving their lives. I think that the hon. Gentleman supports that—I certainly hope so—and I hope that he will persuade other Conservative Members to do so.

The hon. Member for South Cambridgeshire mentioned the tariff for stroke services, which is extremely important. Professor Boyle has been working on that with clinical colleagues in the tariff team, and as a result we have already announced that we are changing the tariff for 2007-08. We will continue to make improvements to it. We are sometimes accused of introducing payment by results too quickly and sometimes of introducing it too slowly; the reality is that we are doing it faster than in almost any other country, because we are determined to get the benefits from that.

Professor Sir Ara Darzi, one of our country’s leading surgeons, who is conducting a review of health care across London, has summed up the changes that are taking place very simply:

That is how the NHS will help more people to stay as healthy and independent as possible, how it will give patients the best and fastest care possible, and how it will deliver the best possible value for the public’s investment.

Of course change is difficult, particularly for the staff affected, and of course changes can be unpopular, particularly when they involve a much loved local hospital. However, if we knew that by changing the way in which services are organised the NHS can improve more people’s lives and save more people’s lives, we would be betraying patients and betraying the NHS if we refused to make those changes just because they involve difficult local decisions. I do not expect Conservative Members to face up to that. No doubt they will go on saying different things to different people, go on saying that they support NHS staff while attacking higher pay and decent pensions, and go on saying that they support change—indeed, that they want independence for the NHS—yet going out on to the streets to oppose every local change that is proposed. They are even organising demonstrations to save hospitals that nobody proposes to change.

Several hon. Members rose—

Ms Hewitt: They say that they believe in the NHS, but they voted against the increased investment, and their new economic policy would mean less money for public services and for the NHS in order to pay for tax cuts—

Several hon. Members rose—

Madam Deputy Speaker: Order. It is obvious that the Secretary of State is not prepared to give way at the moment.

Ms Hewitt: Thank you, Madam Deputy Speaker.

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Real leadership is about being willing to face up to the huge challenges that confront health services, not only in Britain but in every developed country, and where necessary to take the difficult decisions that will be right for patients and for the public.

At the end of the speech by the hon. Member for South Cambridgeshire I had no more idea about what the future of acute services would be under the Conservatives than I had at the beginning of it. We have set out the case for change very clearly. We are supporting the NHS locally to make those changes, and we will continue to do so.

3.16 pm

Norman Lamb (North Norfolk) (LD): I am delighted that we have yet another opportunity to discuss health policy in an Opposition day debate—

Mr. Lansley: All day.

Norman Lamb: Yes—one is tempted to believe that the Conservatives are trying to tell us something. None the less, it is good that we are discussing a matter that is clearly of considerable importance.

There is no doubt that reconfiguration of acute services is a potent political issue. The fact that four Ministers, three of whom are in the Cabinet, are openly objecting to the main thrust of Government policy—

Ms Hewitt indicated dissent.

Norman Lamb: The Secretary of State shakes her head, but there is no doubt that they are. That demonstrates how potent the issue is and what a mess Government policy is in.

The first point to make is that political argument over reconfiguration of acute hospital services is not new. That was demonstrated by the hon. Member for Pudsey (Mr. Truswell), who mentioned six hospitals that had closed under a previous Conservative Government. It has been going on for as long as the NHS has been in existence. However, it is now more controversial than ever before, for reasons that I shall explain later.

To start with, the NHS inherited a patchwork of hospitals from the previous local authority provision, and since then there have been various landmark changes. In 1962, when Enoch Powell was a Health Minister, he published his “Hospital Plan for England and Wales”. He described the role of the district general hospital as having 600 to 800 beds serving a population of 100,000 to 150,000 people, with some specialties being dealt with in larger teaching hospitals. In 1980, we had another landmark Department of Health paper that argued the case for more accessible local hospitals. Throughout that period, under Governments of both parties, a considerable number of smaller, vulnerable hospitals have closed down despite protests from the public.

Interestingly, since this Government came to power in 1997, reconfiguration of services has not been a priority until very recently. The NHS plan in 2000 concentrated on the case for building more hospitals, not closing them. There was a promise of 100 new hospitals by 2010, many financed using the private
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finance initiative. That produces a straitjacket of accommodation that is particularly unsuited to adaptation to take account of changing health needs and priorities. I looked at the 2005 Labour manifesto to see what that said about reconfiguration of hospital services, but there was nothing there. Does that mean that in 2005 the Government had not thought about reconfiguration, or that they had thought about it and kept it from the public debate? Nothing was said about it in the general election campaign, yet it has become a significant part of Government policy since then.

Roger Berry: What did the Liberal Democrat manifesto say about reconfiguration?

Norman Lamb: The hon. Gentleman may have noticed that the Liberal Democrats are not in power. [Interruption.] The hon. Gentleman misses the point. The Government said nothing in the Labour manifesto in 2005, yet the policy has subsequently been implemented with a vengeance. There has been a shift. Did the Government keep it from the public in 2005 or have they invented it since then?

Dr. John Pugh (Southport) (LD): It is fair to record that we were happy with the Government White Paper entitled, “Keeping the NHS local”, which is often cited and completely ignored.

Norman Lamb: My hon. Friend makes a good point. In 2006, reconfiguration was mentioned for the first time in the White Paper, “Our health, our care, our say”. That title bizarrely suggests citizens’ involvement in decisions about future provision. It referred to complementing primary care and community facilities with specialist hospitals. That was the origin of the current round of reconfigurations. It was intended that complex surgery would be undertaken in those specialist hospitals and that there would be full-scale emergency departments. However, the White Paper did not refer to hospital closure.

Let me say a word about the case for reconfiguration, as the hon. Member for Kingswood (Roger Berry) asked about Liberal Democrat policy. There is a case for reconfiguration that is undertaken for the right reasons, and openly and transparently. The motion acknowledges

It implies, although it does not state, that reconfiguration is sometimes necessary or appropriate for improving patient care.

The motion also mentions the need for reconfigurations to be

If we are honest, we should accept that those objectives, which are all worthy, sometimes conflict. Sometimes safety and quality of care are not compatible with the most accessible service. Sometimes choice is constrained. If royal colleges advise that robust mechanisms are in place to determine the numbers that need to be treated in any one year to maintain skill levels and provide sufficient quality of service, we should listen to that advice. The Secretary of State made a similar point.

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